Varicella zoster virus (VZV) is a highly neurotropic human herpesvirus. Primary infection usually causes varicella (chicken pox), after which virus becomes latent in ganglionic neurons along the entire neuraxis. VZV reactivation results in zoster (shingles) which is frequently complicated by chronic pain (postherpetic neuralgia). VZV reactivation also causes meningoencephalitis, myelitis, ocular disorders, and vasculopathy, all of which can occur in the absence of rash. This review focuses on the association of VZV and stroke, and on the widening spectrum of disorders produced by VZV vasculopathy in immunocompetent and immunocompromised individuals, including recipients of varicella vaccine. Aside from ischemic stroke, VZV infection of cerebral arteries may lead to development of intracerebral aneurysms, with or without hemorrhage. Moreover, recent clinical-virological case reports and retrospective pathological-virological analyses of temporal arteries positive or negative for giant cell arteritis (GCA) indicate that extracranial VZV vasculopathy triggers the immunopathology of GCA. While many patients with GCA improve after corticosteroid treatment, prolonged corticosteroid use may potentiate VZV infection, leading to fatal vasculopathy in the brain and other organs.
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The study was supported by grants from the National Institutes of Health (NS093716 to Dr. Gilden, AG032958 to Dr. Gilden and Dr. Nagel, and NS094758 to Dr. Nagel). We thank Marina Hoffman for the editorial review and Cathy Allen for the manuscript preparation.
Compliance with Ethical Standards
Conflict of Interest
Maria A. Nagel has received the following grant: NIH/NINDS R01, Purinergic Signaling in Varicella Zoster Virus Vasculopathy.
Don Gilden has received the following grants: NIH/NIA PPG, Molecular Pathogenesis of Varicella Zoster Virus Infection, and NIH/NINDS R01, Neurobiology of Varicella Zoster Virus.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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